Recurrent femoral deep vein thrombosis: Rare complication of a pelvic mass induced by polyethylene wear debris following total hip arthroplasty. A case report

Hip Arthroplasty Pseudotumors: Pathogenesis, Imaging, and Clinical Decision Making

Pseudotumors are a complication of hip arthroplasty. The goal of this article is to review the clinical presentation, pathogenesis, histology, and the role of diagnostic imaging in clinical decision making for treatment, and surveillance of pseudotumors. We will discuss the multimodal imaging appearances, differential diagnosis, associated complications, treatment, and prognosis of pseudotumors, as an aid to the assessment of orthopedic prostheses at the hip.

Sciatic nerve compression by an extrapelvic cyst secondary to wear debris after a cementless total hip arthroplasty: A case report and literature review

INTRODUCTION

Polyethylene (PE) wear debris after total hip arthroplasty (THA) may cause formation of a soft tissue mass due to inflammatory reaction. To the best of our knowledge we report the first case in whom the diagnosis was made after examination of the hip, pelvis and lumbar spine with detailed radiological methods and the plain radiographs showed no signs of loosening of the THA.

PRESENTATION OF CASE

We report a 52 years-old woman who presented with a cyst causing sciatic irritation in her gluteal region due to wear debris after THA. Magnetic resonance imaging (MRI) was useful in detecting the cyst. Resolution of the cyst occured after subtotal cystectomy and revision of the acetabular components.

DISCUSSION

Although plain radiographs can show signs of the underlying pathology; such as osteolysis, loosening of the components and wear of the PE liner, they are unable to detect cystic lesions. Cystic lesions may be an early sign of wear debris.

CONCLUSION

This case shows us that sciatic neuropathy with no evidence of nerve root impingement on lumbar MRI in a patient with THA requires also examination of the hip and pelvis with detailed radiological methods, such as MRI, in addition to plain radiography. Removal of the source of debris via revision surgery following subtotal cystectomy leads to the resolution of the remaining portion of the cyst and also relief of the symptoms of sciatic nerve compression.

Inflammatory pseudotumor causing deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty

Metal-on-metal hip resurfacings have recently been associated with a variety of complications resulting from adverse reaction to metal debris. We report a case of extensive soft tissue necrosis associated with a huge pelvic mass causing extensive deep vein thrombosis of the lower limb secondary to mechanical compression of the iliac vein. This is a rare and unusual cause of deep vein thrombosis after metal-on-metal hip resurfacing arthroplasty.

[Femoral superficial vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty]

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet(®)), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7 cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein.

Management of a pelvic mass following a worn uncemented total hip arthroplasty

Intrapelvic granulomatous masses from polyethylene wear debris can easily be misdiagnosed if orthopaedic etiology is not considered. This article presents the case of a 50 year old woman with history of hip joint trauma and total hip arthroplasty (THA) revisions who presented to her gynecologist with a large intrapelvic cyst. Prolonged use of an indwelling drain and failure to recognize the orthopaedic origin of the mass resulted in articular infection that required an antibiotic spacer and subsequent THA revision. This patient did not have pain or evidence of medial wall defects, but did have a history of trauma, revision arthroplasty and acetabular allograft. In the presence of these findings, wear-induced polyethylene debris should be considered in the differential diagnosis of the pelvic mass.